20201011 Ver 1_Shoreline Stabilization_20200803

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j�'; � L� _�) � � � � � ��-�� C'� State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H .0500 -Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY FORM; 55GP 02-2017
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and.. the application fee should be sent to:
If sending via US Postal Service If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins Karen Higgins
DWR — 401 &Buffer Permitting Branch DWR — 401 &Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC27699-1617 Raleigh, NC27604 DECEIVED
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
AUG 0 3 2020
Name: JOHN & LESLIE PEDERNALES nlrn�nm�niQ�NPDES
Mailing Address: 1511 HUGH FOREST RD
_____ CHARLOTTE_N__C 28270
Telephone Number: 704-241-4388 Fax Number:
E-mail Address:
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
htto://www.saw.usace.armv.mil/Portals/59/does/reeulatorv/re�docs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name: CARISSA PARKER
Company Affiliation: BENNICK ENTERPRISES. LLC.
Mailing Address: 7836 HWY 70 EAST
NEBO NC 28761
Telephone Number: 828-659-1000 Fax Number: 828-659-1001
E-mail Address: [e-mail]
B. Project Information [15A NCAC 02H .0502(a) & (b)]
1. Attach a vicinity map (i.e. street map) clearly showing the location of the property with
respect to local landmarks such as towns, rivers, and roads.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, buildings, retaining walls, docks, impervious surfaces, rip rap, excavation
or dredging below Full Pond/ Normal Water Level elevations, and construction access
corridors. You may use the diagram provided at the end of this application form.
FORM: SSGP 02-2017 Page 1 of 3

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3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of
some sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be cond
County: MCDOWELL Nearest To'
Lake/ river/ ocean adjacent to property:
Property size (acres):
Subdivision name or site address (include phase/lot
NEBO
ber): 1780 LOT 190
Directions to site -please include road names and numbers, landmarks, etc.:
FROM MORGANTON TAKE HWY 126 / TL ONTp CARBON DR / TR ONTO YELLOW FORK
Latitude (in decimal degrees) 35.74284 Longi�ude (decimal degrees) 81.90649
5. Describe the existing land use or condition of the site�at the time of this application
(residential, undeveloped, etc.):
6. Describe proposed work (include discussion as to
avoided, or why it is necessary):
HEIGHT WILL BE 9'
hardening of shoreline has been
7. Will work be conducted from land? ❑ �! From water?
8. Total amount of impacts below the normal pool lake level /Normal Water Level
Permanent impacts (including all excavation, backfill„rip rap, retaining walls, etc.) in square feet:
6' X 140' = 840 SQ FT'
Temporary impacts in square feet:
NO TEMP IMPACT
9. Total amount of impacts above the normal pool lake level /Normal Water Level and 50 feet
land -ward
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
3' X 140' = 420 SQ FT
Temporary impacts (temporary clearing, construction corridor) in square feet:
NO TEMP IMPACT
10. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50
feet landward to be impacted (number of trees, for instance): 5 TREES LESS THAN 6" AND
3 TREES GREATER THAN 6" WILL BE REMOVED TO COMPLETE THIS PROJECT. THEY WILL BE
REPLACED INCH FOR INCH WITH TREES TOTALING THE SAME DIAMETER. ANY REMAINING
DISTURBED AREA WILL HAVE MULCH APPLIED TO IT
FORM: SSGP 02-2017 Page 2 of 3

11. Signa � Q
O�U
Owner gent's Sig ture� [15A NCAC 2H .05021f)1 D to
`Agent's signature is valid only if an authorization letter from the owner is provided.
12. Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Lake
(�1t Fuil Pond/ Normak Water Level}
i
i
I
Fuld Pond/Normal'U'Vater Level
��.���..
Shoreline
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�I�n Viev�
FORM: SSGP 02-2017 Page 3 of 3

1780 LOT 190
i
TO: NORTH CAROLINA DIVISION OF WATE�2 RESOURCES
i
I GIVE CARISSA PARKER, OF BENNICK ENTERPRISES, LLC.,
PERMISSION TO SIGN AS MY AGENT ON MY APPLICATION FOR
SHORELINE STABILIZATION.
SICI`IATLJR:E
DATE l 6 Z"�2"fl

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John &Leslie Pedernales
1780 lot 190

Pedernales - 1780 190
J a m e s
My Pushpins
John Pedernales
1780 lot 190
2020 Yellow Fork Trl W
Latitude: 35.74284 N
Longitude: 81.90649 W
0 yds 100 200 300 400
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